Can We Restore Vision? A Cadaveric Study Using Hyaluronidase for Retinal Artery Occlusion

Abeer Kalandar 1, Jason Williams 1, Donald Lalonde 1

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PMID: 31741812


PMCID: PMC6799401

Despite the gloomy outlook of this problem, there are 2 recent reports of possible reversal of partial blindness with supraorbital injection of hyaluronidase.4,5 We therefore decided to see where hyaluronidase goes when it is injected into and around the eye. The authors use video to illustrate 4 injection techniques in 5 human cadaver heads (10 halves). The goal was to see where hyaluronidase is distributed when injected by the following 4 approaches: inferolateral orbit, supraorbital foramen, infraorbital foramen, and intravitreous. We also attempted to deliver the intravascular hyaluronic acid filler into the retinal vessels after injecting Juvederm-Volbella (Allergan Inc., ON, Canada) mixed 9:1 with methylene blue into each of 10 angular and/or facial arteries of 10 halves of the head. . We injected hyaluronidase 1500 iU/ml (York Downs, ON, Canada) mixed 9:1 with dye. Each area was injected until the dye was seen bulging the eyelid fat under the skin. Thirty to 40 minutes after the injections, globe dissection was performed in all 10 orbits with enucleation and examination of the retinal neurovascular bundles to see where the hyaluronic acid and hyaluronidase went with their different colors. (See Video 1 [online], which demonstrates the lateral orbital injection.) (See Video 2 [online], which demonstrates the supraorbital foramen injection.) (See Video 3 [online], which demonstrates the infraorbital foramen injection.) (See Video 4 [ online], which demonstrates intravitreal injection.) We did not get the hyaluronic filler to reach the retinal artery in any of the cadavers as we were unable to inject the filler into smaller arteries in this model. Although the dye solution containing hyaluronidase was clearly seen to enter the fat surrounding the retinal neurovascular bundle at the back of the orbit at all four approaches, we could not see it penetrating the fascia surrounding the retinal vascular bundle and therefore reason did not enter the adipose tissue adjacent to the retinal artery. We were unable to demonstrate adequate perivascular or intravascular hyaluronidase infiltration into or around the retinal artery with any of the 4 approaches in this cadaver model.



DOI: 10.1097/GOX.0000000000002412